BACKGROUND Mediastinal emphysema is a condition in which air enters the mediastinum between the connective tissue spaces within the pleura for a variety of reasons.It can be spontaneous or secondary to chest trauma,es...BACKGROUND Mediastinal emphysema is a condition in which air enters the mediastinum between the connective tissue spaces within the pleura for a variety of reasons.It can be spontaneous or secondary to chest trauma,esophageal perforation,medi-cally induced factors,etc.Its common symptoms are chest pain,tightness in the chest,and respiratory distress.Most mediastinal emphysema patients have mild symptoms,but severe mediastinal emphysema can cause respiratory and circulatory failure,resulting in serious consequences.CASE SUMMARY A 75-year-old man,living alone,presented with sudden onset of severe epigastric pain with chest tightness after drinking alcohol.Due to the remoteness of his residence and lack of neighbors,the patient was found by his nephew and brought to the hospital the next morning after the disease onset.Computed tomography(CT)showed free gas in the abdominal cavity,mediastinal emph-ysema,and subcutaneous pneumothorax.Upper gastrointestinal angiography showed that the esophageal mucosa was intact and the gastric antrum was perforated.Therefore,we chose to perform open gastric perforation repair on the patient under thoracic epidural anesthesia combined with intravenous anesthesia.An operative incision of the muscle layer of the patient's abdominal wall was made,and a large amount of subperitoneal gas was revealed.And a continued incision of the peritoneum revealed the presence of a perforation of approx-imately 0.5 cm in the gastric antrum,which we repaired after pathological examination.Postoperatively,the patient received high-flow oxygen and cough exercises.Chest CT was performed on the first and sixth postoperative days,and the mediastinal and subcutaneous gas was gradually reduced.CONCLUSION After gastric perforation,a large amount of free gas in the abdominal cavity can reach the mediastinum through the loose connective tissue at the esophageal hiatus of the diaphragm,and upper gastrointestinal angiography can clarify the site of perforation.In patients with mediastinal emphysema,open surgery avoids the elevation of the diaphragm caused by pneumoperitoneum compared to laparoscopic surgery and avoids increasing the mediastinal pressure.In addition,thoracic epidural anesthesia combined with intravenous anesthesia also avoids pressure on the mediastinum from mechanical ventilation.展开更多
BACKGROUND Many cases of emphysema associated with blow-out fractures occur before surgery due to trauma.However,emphysema can occur even after surgery,and most of such cases are managed conservatively and allowed to ...BACKGROUND Many cases of emphysema associated with blow-out fractures occur before surgery due to trauma.However,emphysema can occur even after surgery,and most of such cases are managed conservatively and allowed to resolve.Swelling in the periorbital area due to emphysema that occurs after surgery can make early recovery difficult.CASE SUMMARY Herein,we describe a case of postoperative subcutaneous emphysema that was treated using a simple needle aspiration method.A 48-year-old male patient visited the hospital with a blow-out fracture of the left medial orbital wall and nasal bone fracture.One day postoperatively,swelling and crepitus in the left periorbital area were observed,and follow-up computed tomography showed emphysema in the left periorbital subcutaneous area.Needle aspiration using an 18-gauge needle and syringe was used to relieve the emphysema.The symptoms of sudden swelling improved immediately,and no recurrence was observed.CONCLUSION We conclude that needle aspiration is a useful method that could help in relieving symptom,resolving discomfort,and enabling early return to daily life in patients with postoperative subcutaneous emphysema.展开更多
BACKGROUND Subcutaneous emphysema is a well-known complication of oral surgery,especially during mandibular wisdom tooth extraction.However,subcutaneous emphysema secondary to dental procedures such as crown preparati...BACKGROUND Subcutaneous emphysema is a well-known complication of oral surgery,especially during mandibular wisdom tooth extraction.However,subcutaneous emphysema secondary to dental procedures such as crown preparation is rare.The main symptom of emphysema is swelling and crepitus on palpation.Uncontrolled emphysema may spread along the fascial planes and cause deep space infections or a pneumomediastinum.CASE SUMMARY In this paper,we report a 34-year-old female who underwent upper molar tooth preparation for crowns and subsequently developed extensive subcutaneous emphysema on the retromandibular angle on two different occasions.The treatment plan for this patient involved close observation of the airway,and administration of dexamethasone and antibiotics via intravenous drip or orally.Ice bag compression was quickly applied and medication was prescribed to alleviate discomfort and promote healing.Although the main reason is unclear,the presence of a fissure in the molar is an important clue which may contribute to the development of subcutaneous emphysema during crown preparation.It is imperative for dental professionals to recognize such pre-disposing factors in order to minimize the risk of complications.CONCLUSION This case highlights the need for prompt diagnosis and management of subcutaneous emphysema because of the risk of much more serious complications.Awareness of relatively“benign”subcutaneous emphysema during any dental procedure is critical not only for inexperienced dentists,but also for those who work in rural and remote settings as members of surgical teams.In this study,we review the clinical presentation,mechanism,and differential diagnosis of subcutaneous emphysema.展开更多
Background:Delayed mediastinal emphysema with subcutaneous emphysema after extubation is rarely reported in current literature.Symptomatic treatment is considered effective for management.Case presentation:We report a...Background:Delayed mediastinal emphysema with subcutaneous emphysema after extubation is rarely reported in current literature.Symptomatic treatment is considered effective for management.Case presentation:We report a case of a 56-year-old female with longstanding rheumatoid arthritis under corticosteroid therapy who developed mediastinal emphysema with subcutaneous emphysema 2 days after recovering from general anesthesia for orthopedic surgery treating a femoral neck fracture.The patient received aggressive subcutaneous decompression and symptomatic management.Results:The patient’s condition improved after treatment.Based on computed tomography scan results,we hypothesize that the longstanding rheumatoid arthritis may have resulted in fragile lung tissue.Violent postoperative coughing likely caused rupture of small airways,leading to mediastinal emphysema.Conclusions:It is crucial to preoperatively assess the risk of airway injury in high-risk patients with longstanding rheumatoid arthritis.Delayed postoperative mediastinal emphysema should be carefully evaluated and managed aggressively to avoid exacerbation or life-threatening scenarios.Further research is warranted to elucidate the pathology and guide perioperative management in these patients.展开更多
目的围绕上海某三级医院引进支气管镜热蒸汽消融术配套医疗设备的有效性、安全性、适宜性、经济性开展医院卫生技术评估(Hospital-Based Health Technology Assessment,HB—HTA),探索该工具在创新医疗设备领域的应用。方法以欧盟HB-HTA...目的围绕上海某三级医院引进支气管镜热蒸汽消融术配套医疗设备的有效性、安全性、适宜性、经济性开展医院卫生技术评估(Hospital-Based Health Technology Assessment,HB—HTA),探索该工具在创新医疗设备领域的应用。方法以欧盟HB-HTA指导手册中的医疗设备新技术引进评估模板为框架开展研究。结果文献研究结果显示,经支气管镜热蒸汽消融治疗患者FEV1%、SGRQ、6MWD得到明显改善,不良事件能够通过标准护理得到解决;通过专家咨询、小组讨论结合真实世界数据分析结果显示,设备具备人员场地条件,符合医院学科发展规划,具有技术适宜人群,设备乐观估计6年左右收回成本,单个人的疾病负担减轻。结论支气管镜热蒸汽消融技术能有效改善患者肺功能,提高患者生活质量,安全性较好,具有配置价值;能带动呼吸介入治疗中心发展,有助于提升重度肺气肿诊疗水平,该研究模式可为医院新技术引入提供决策证据,提高医院医疗设备管理水平。展开更多
文摘BACKGROUND Mediastinal emphysema is a condition in which air enters the mediastinum between the connective tissue spaces within the pleura for a variety of reasons.It can be spontaneous or secondary to chest trauma,esophageal perforation,medi-cally induced factors,etc.Its common symptoms are chest pain,tightness in the chest,and respiratory distress.Most mediastinal emphysema patients have mild symptoms,but severe mediastinal emphysema can cause respiratory and circulatory failure,resulting in serious consequences.CASE SUMMARY A 75-year-old man,living alone,presented with sudden onset of severe epigastric pain with chest tightness after drinking alcohol.Due to the remoteness of his residence and lack of neighbors,the patient was found by his nephew and brought to the hospital the next morning after the disease onset.Computed tomography(CT)showed free gas in the abdominal cavity,mediastinal emph-ysema,and subcutaneous pneumothorax.Upper gastrointestinal angiography showed that the esophageal mucosa was intact and the gastric antrum was perforated.Therefore,we chose to perform open gastric perforation repair on the patient under thoracic epidural anesthesia combined with intravenous anesthesia.An operative incision of the muscle layer of the patient's abdominal wall was made,and a large amount of subperitoneal gas was revealed.And a continued incision of the peritoneum revealed the presence of a perforation of approx-imately 0.5 cm in the gastric antrum,which we repaired after pathological examination.Postoperatively,the patient received high-flow oxygen and cough exercises.Chest CT was performed on the first and sixth postoperative days,and the mediastinal and subcutaneous gas was gradually reduced.CONCLUSION After gastric perforation,a large amount of free gas in the abdominal cavity can reach the mediastinum through the loose connective tissue at the esophageal hiatus of the diaphragm,and upper gastrointestinal angiography can clarify the site of perforation.In patients with mediastinal emphysema,open surgery avoids the elevation of the diaphragm caused by pneumoperitoneum compared to laparoscopic surgery and avoids increasing the mediastinal pressure.In addition,thoracic epidural anesthesia combined with intravenous anesthesia also avoids pressure on the mediastinum from mechanical ventilation.
基金Supported by Soonchunhyang research fund,No.2023-0024.
文摘BACKGROUND Many cases of emphysema associated with blow-out fractures occur before surgery due to trauma.However,emphysema can occur even after surgery,and most of such cases are managed conservatively and allowed to resolve.Swelling in the periorbital area due to emphysema that occurs after surgery can make early recovery difficult.CASE SUMMARY Herein,we describe a case of postoperative subcutaneous emphysema that was treated using a simple needle aspiration method.A 48-year-old male patient visited the hospital with a blow-out fracture of the left medial orbital wall and nasal bone fracture.One day postoperatively,swelling and crepitus in the left periorbital area were observed,and follow-up computed tomography showed emphysema in the left periorbital subcutaneous area.Needle aspiration using an 18-gauge needle and syringe was used to relieve the emphysema.The symptoms of sudden swelling improved immediately,and no recurrence was observed.CONCLUSION We conclude that needle aspiration is a useful method that could help in relieving symptom,resolving discomfort,and enabling early return to daily life in patients with postoperative subcutaneous emphysema.
基金Supported by Shenzhen Science and Technology Program,No.JCYJ20220530165409022.
文摘BACKGROUND Subcutaneous emphysema is a well-known complication of oral surgery,especially during mandibular wisdom tooth extraction.However,subcutaneous emphysema secondary to dental procedures such as crown preparation is rare.The main symptom of emphysema is swelling and crepitus on palpation.Uncontrolled emphysema may spread along the fascial planes and cause deep space infections or a pneumomediastinum.CASE SUMMARY In this paper,we report a 34-year-old female who underwent upper molar tooth preparation for crowns and subsequently developed extensive subcutaneous emphysema on the retromandibular angle on two different occasions.The treatment plan for this patient involved close observation of the airway,and administration of dexamethasone and antibiotics via intravenous drip or orally.Ice bag compression was quickly applied and medication was prescribed to alleviate discomfort and promote healing.Although the main reason is unclear,the presence of a fissure in the molar is an important clue which may contribute to the development of subcutaneous emphysema during crown preparation.It is imperative for dental professionals to recognize such pre-disposing factors in order to minimize the risk of complications.CONCLUSION This case highlights the need for prompt diagnosis and management of subcutaneous emphysema because of the risk of much more serious complications.Awareness of relatively“benign”subcutaneous emphysema during any dental procedure is critical not only for inexperienced dentists,but also for those who work in rural and remote settings as members of surgical teams.In this study,we review the clinical presentation,mechanism,and differential diagnosis of subcutaneous emphysema.
基金This work was supported by the Chen Xiao-ping Foundation for the Development of Science and Technology of HuBei Province:“Rui”special research fund[grant number CXPJJH1200000-07-113]。
文摘Background:Delayed mediastinal emphysema with subcutaneous emphysema after extubation is rarely reported in current literature.Symptomatic treatment is considered effective for management.Case presentation:We report a case of a 56-year-old female with longstanding rheumatoid arthritis under corticosteroid therapy who developed mediastinal emphysema with subcutaneous emphysema 2 days after recovering from general anesthesia for orthopedic surgery treating a femoral neck fracture.The patient received aggressive subcutaneous decompression and symptomatic management.Results:The patient’s condition improved after treatment.Based on computed tomography scan results,we hypothesize that the longstanding rheumatoid arthritis may have resulted in fragile lung tissue.Violent postoperative coughing likely caused rupture of small airways,leading to mediastinal emphysema.Conclusions:It is crucial to preoperatively assess the risk of airway injury in high-risk patients with longstanding rheumatoid arthritis.Delayed postoperative mediastinal emphysema should be carefully evaluated and managed aggressively to avoid exacerbation or life-threatening scenarios.Further research is warranted to elucidate the pathology and guide perioperative management in these patients.
文摘目的围绕上海某三级医院引进支气管镜热蒸汽消融术配套医疗设备的有效性、安全性、适宜性、经济性开展医院卫生技术评估(Hospital-Based Health Technology Assessment,HB—HTA),探索该工具在创新医疗设备领域的应用。方法以欧盟HB-HTA指导手册中的医疗设备新技术引进评估模板为框架开展研究。结果文献研究结果显示,经支气管镜热蒸汽消融治疗患者FEV1%、SGRQ、6MWD得到明显改善,不良事件能够通过标准护理得到解决;通过专家咨询、小组讨论结合真实世界数据分析结果显示,设备具备人员场地条件,符合医院学科发展规划,具有技术适宜人群,设备乐观估计6年左右收回成本,单个人的疾病负担减轻。结论支气管镜热蒸汽消融技术能有效改善患者肺功能,提高患者生活质量,安全性较好,具有配置价值;能带动呼吸介入治疗中心发展,有助于提升重度肺气肿诊疗水平,该研究模式可为医院新技术引入提供决策证据,提高医院医疗设备管理水平。
文摘目的探讨血清肿瘤坏死因子相关凋亡诱导配体(TRAIL)水平与晚期非小细胞肺癌(NSCLC)患者免疫治疗反应的关联性。方法回顾性分析2019年1月至2020年5月唐山市人民医院收治的70例晚期NSCLC患者的临床资料。在免疫治疗前24 h内采用酶联免疫吸附试验法(ELISA)测定患者血清TRAIL水平。免疫治疗反应通过客观缓解率(ORR)和临床获益率(CBR)进行评估。分析患者血清TRAIL水平与免疫治疗反应、肺功能及肺气肿、临床预后的关联性。结果经免疫治疗后,NSCLC患者获得客观缓解23例,临床获益46例。获得客观缓解患者的血清TRAIL水平显著高于未获得客观缓解者[27.77(23.13,39.13)pg/mL vs 12.36(8.76,18.15)pg/mL;Z=4.508,P<0.001]。临床获益患者的血清TRAIL水平显著高于临床未获益者[23.13(16.99,30.63)pg/mL vs 11.75(8.76,15.56)pg/mL;Z=4.887,P<0.001]。Spearman秩相关性分析结果显示,血清TRAIL水平与1秒用力呼气容积/用力肺活量(FEV1/FVC)呈正相关(rs=0.288,P=0.016),与肺气肿总比值(rs=-0.257,P=0.032)、肺叶肺气肿比率(LER)(rs=-0.324,P=0.006)呈负相关。多因素logistic回归分析结果显示,以血清TRAIL>27.46 pg/mL为参考,血清TRAIL<18.15 pg/mL患者经免疫治疗不能获得客观缓解和临床获益的风险显著增加(P<0.05)。ROC曲线分析结果显示,血清TRAIL水平可有效预测NSCLC患者对免疫治疗的反应(P<0.05)。TRAIL高水平组(血清TRAIL≥18.15 pg/mL)的总体生存(OS)、无进展生存(PFS)预后显著优于TRAIL低水平组(血清TRAIL<18.15 pg/mL)(P<0.05)。结论血清TRAIL低水平与晚期NSCLC患者免疫治疗无反应以及临床预后不良有关,该指标监测有助于筛选能从免疫治疗中获益的NSCLC患者。
